Author: mazels2014

Active Learning for CVI: In Support of Learning Concepts

Here is a wonderful article by Rachel Bennett as part of the CVI Overview class at UMASS Boston. The assignment was: Create an Active Learning space or material for a child in Phase II of CVI. Post a picture and explain what you created and why it will be appropriate for this child in Phase II with CVI. Amazing adaptations for accessible learning and self discovery, Rachel!

Active Learning story box for ​Llama Llama Nighty Night

What is this?​ Using a magnet board, tactile schedule icons familiar to the student, a Llama doll, and pre-recorded button, the student can engage in the story sequence in a multimodal way: tactual, visual, and auditory. The yellow button is positioned on the right up off the table using an upside black bin. I recorded the story of ​Llama Llama Nighty Night​, so when the student presses the button, the story will begin. This is an activity that can be completed in phases and with complexity of array is continually assessed. To start, the student can press the button and then hold and engage with the Llama doll. We can then add a tactile schedule icon one-by-one depending on motivation and interest. For example, the child was able to engage with the recorded button, Llama doll, and two schedule icons. He touched and removed the toothbrush when he heard the phrase, “time to brush,” and touched and removed the book when heard, “choose a book.”

Why is this appropriate for a student in Phase II? ​

The activity allows to adjust materials so they are in the student’s preferred visual field (slant board, magnet board, black bin). Complexity of array and background are reduced, along with the use of intentional and familiar items. By making the icons tactile, this allows for the opportunity for sensory balance, using touch as a bridge to vision. Highly saturated, vibrant colors are used for each item. Preferred color is used for the recorded button.

Playing with Light Pucks

 

What is this?​ Using a magnet board, LED light pucks, and an adhesive magnet squares, several skills can be explored! Each light puck has 5 settings: white, red, green, blue, off. Possible skills to explore: 1 to 1 counting (the puck themselves or with each click when pushing the light), colors, color matching, on/off, positions (under, next to, right, left, above, in between), shape (round, curved, circle), cause and effect.

Why for Phase II?​ Reduced complexity of background, array, object; need for light and color; preferred visual field; materials at near. Tactile exploration allows for sensory balance.

Exploration of the concepts of round, curved, like a circle!

What is this?​ Using a magnet board, various round/curved items, and adhesive magnet squares, the student explores the concept of roundness/curved/like a circle to support future learning of salient features (Roman Lantzy). Some items are familiar (light puck, play orange, orange top of a familiar play container), and some items are new. The student can explore each item tactually, take them off, and place them back on the board. Non examples of round items can be added, such as Tegu magnet wooden blocks. The student can sort/match round items and straight items. The array of items can be controlled depending on what the student visually processes at their comfortable and beginning challenging level.

Why for Phase II?​ Reduced complexity of background, array, object; color; preferred visual field; materials at near; use of some familiar items. Tactile exploration allows for sensory balance.

How long can it be?

What is this?​ Brightly colored rope is placed in an oatmeal container that is painted black. There is a cross slit on the lid and yellow duct tape to reinforce tip of string. The student can pull the string, roll the container, swing the string and container back and forth. Skills: pull, cause & effect, long/short, in/out.

Why for Phase II?
Reduced complexity of background, array, object; color; materials at near; preferred visual field; movement. Tactile exploration allows for sensory balance.

Pully tube fun!

What is this?​ A simple item that can be used to explore various concepts and skills: pull, sound, cause & effect, long/short, round/straight. Using against a black background. Prop black board (card board with black felt) on slant board and hang tube. Hot glue string to one end of the tube and tie string around small holes created on top of board. The student can move the tubes around, pull, and tactually explore. Create a circular shape with one of the tubes and place next to a pully tube that has not been transformed.

Why for Phase II?​ Reduced complexity of background, array, object; color; preferred visual field; materials at near; movement. Tactile exploration allows for sensory balance.

CVI as Part of the NEI Strategic Plan: Please help!

Take a minute to have your voice heard!

NEI Seeks Input on Strategic Plan

On November 22, 2019, the National Eye Institute (NEI) issued a Request for Information regarding its Strategic Plan, entitled 2020 Vision for the Future, with a response date of January 8, 2020. Building upon its last Plan issued in 2012, NEI seeks broad input from researchers, clinicians, patients, vision advocates, and the public regarding research needs, opportunities, and areas for emphasis in the next five years––including needs and gaps in research, health, and quality of life. NEI has proposed seven cross-cutting areas of emphasis to foster input, including Genes, Neuroscience, Immune System and the Eye, Regenerative Medicine, Data Science, Individual Quality of Life, and Public Health and Disparities Research.

Click on the following link to access NEI’s request, which includes a response section:  https://www.nei.nih.gov/form/rfi

Advocacy: High School Student with CVI

I completed an assessment for a student with CVI and shared the report with her. Please check out the amazing document she created for her teachers in her own words. Amazing! This is what self advocacy looks like! Self advocacy is a key Expanded Core Curriculum area that should be on every IEP.

  • I know myself and my needs best! It’s important to think about how the people I work with can support me, and share those strategies with you so that I can be successful.
  • Please use this information to help me rely on my vision more and more by setting up the environment in a way that’s easier for me.
  • These are suggestions for how to prevent me from getting too tired too quickly, especially during the school day.
  • My vision might be a little different every day, or even change throughout the course of one day because I am tired.
  • Let’s discuss my CVI schedule that would be helpful for me. This includes taking breaks from using my vision before I get tired so that I can use my vision more and more throughout the day.

Background about Me:
Ophthalmological History

  • I have healthy eyes that don’t explain the level of vision I experience.
  • I have some difficulty with seeing both near and far
  • I have some difficulty seeing color, especially if two similar colors are side by side (i.e. light colored piece of paper on light colored table)
  • It might be harder for me to see in the center of my visual field than on the sides

Neurological History

  • I experience seizures & migraines because of the structure of my brain. This can impact how I see on different days.

My CVI Visual Behaviors

These are specific visual behaviors that the CVI assessment told me about. This is based on things that myself and my mother shared, and what the team saw the day I did the testing.

  • My favorite color, blue, helps to draw my attention visually. I can look at things that have 2-3 different colors.
  • When things move, it helps get my visual attention, especially if it’s out in the room and not very close to me. This might look like someone walking past me in the hallway, or outside an open door. This is not something I can control. I process better when things move gently or slowly instead of quickly.
  • Familiar things are easier for me to look at because I don’t have to use my visual energy to figure them out. When I get tired, its harder for me to rely on my eyes as much, and I prefer to rely on my hearing and touch more.
  • My visual field is the whole area in front of me that I have the potential to see. Think of it as a square that moves with me-it has boundaries on both sides, and on the top and bottom. If I want to see past those boundaries, I have to move my head. I sometimes don’t notice things in the bottom part of my visual field. This is why my cane helps me avoid tripping over things or noticing changes on the floor.
  • It’s easier for me to see from my left side, and it can be difficult to use my eyes together to look in the center of my visual field.
  • Depending on what’s going on around me, it can be easier or more difficult for me to rely on my vision. If there’s a lot of activity, people, or stuff around me, it can make it more difficult for my vision to get an accurate picture of what I’m looking at.
  • It’s easier for me to identify things based on real photographs or realistic drawings rather than sketches or symbols of the object.
  • If surfaces, drawers, shelves, etc. are too crowded, it might be difficult to rely on my vision to find what I need. I do better when I’m looking at a smaller area with lots of space between objects.
  • Places like a busy supermarkets or crowded place can make it very difficult for me to use my vision. Noisy places can be challenging for me.
  • It can be difficult to identify a person, even someone I know very well, when I’m in a crowded place. This is partially because of the amount of information my brain is receiving at once.
  • Light helps to draw my visual attention, especially light from a phone or computer, since its coming from “behind” the information on the screen. Sometimes light can be distracting for me.
  • I have an easier time looking at things that are closer to me, about an arm’s length away or so. If something is moving or makes noise, it might be easier to see from farther away.
  • It can be easier to identify and locate things in a familiar place, like my bedroom. I can learn about new objects using my vision and other senses. It might be easier on certain days and in certain environments (quiet v. loud) than others.
  • It’s easier for me to find things and reach for them when there’s less stuff in the background. It helps if there’s lots of space around the object, good lighting, and a plain background. For example, it might be easier for me to pick up a solid color water bottle from an empty table then to find a multicolored necklace in a drawer with other jewelry.
  • When my eyes and brain get tired, I often rely on my other senses (hearing and touch) to get the information I need.
  • Busy, noisy, and new places can make it more difficult for me to use my vision. It might take me longer, or feel like a lot more work.
  • It helps if I face away from busy places like the door, windows, or other lights. This helps keep movement and light out of my visual field so that I’m not distracted and my brain isn’t working too hard to understand what it’s seeing.
  • Sitting slightly turned to the left at the table helps me see out of the strongest part of my visual field.
  • It might be helpful for people to tell me something about their appearance (hair color, glasses, height) or what they’re wearing in order for me to be able to recognize them later on, even from further away. This is something I might have to ask people to do.
  • Asking someone to say my name before they start talking to me might help me pay attention earlier, so I hear everything they say.
  • It helps me when staff are available to help by giving me information about what’s going on around me.
  • Bright, deep colors can help draw my attention and highlight the important parts of an object, or serve as landmarks when I’m moving around.
  • Blocking out movement and noise will help me from being distracted. This might look like sitting facing away from doors and windows, or in a corner with two walls near me.
  • Continuing to work with me in O&M will help me with strategies for safe movement
  • It’s important to take breaks before I feel tired or “overloaded”. I have to give my brain time to process what I’m looking at, especially if it’s something new.
  • Organization, organization, organization! The more consistent and easy to navigate an area is, the more independence I will have.
  • It helps if I use objects with 1-3 colors, use familiar items when I’m learning about something new, use the “real thing” instead of drawings of something so that it’s easier to understand, use backlighting from iPads, laptops, etc. when looking at photos and pictures of things and use a blue line marker can help when I’m reading print.
  • Slow movement can help draw my attention.
  • Taking my time when learning new information, taking breaks, etc. can be helpful, especially in the afternoon when I feel more tired.
  • Using a slant board can bring things into a visual field that’s easier for me to see.
  • Organization, routine, and consistency are my friends when I’m learning!

How Often to Assess Learners with CVI?

It has always been best practice in our field of visual impairment to assess children with any visual impairment at least yearly if they have a possibility of changing visual skills.

For kids with ocular impairments (degenerative conditions, damage to the eye or surgeries), sadly this change is usually a reduction in vision. You need the assessment to make sure the materials and methods match the current visual skills to ensure that learning has the optimal visual access.

For kids with CVI, the possibility of visual improvement changes warrant an assessment yearly so the materials and methods match the current visual skill. Waiting for the typical three year re-evaluations might miss a positive vision changes and materials and methods might not match the new visual skills.

Troubling Misuse of Promising Practice

When a new approach to teaching learners with CVI is suggested, we need to ask ourselves:

  • Does this match our understanding of the unique learner’s visual behaviors?
  • Is there scientific research to support the use of this strategy?
  • If there is no scientific research, is it a “promising practice” that we can carefully try and carefully apply to each unique student’s situation?
  • How do we decide to use this “promising practice”?
  • How do we use it as it was meant to be used?
  • How do we evaluate its effectiveness since not all inventions will be useful for all learners? (I hope the words collect data popped into your mind here!)

Recently I visited a school to consult for a student who was barely using any central vision to access literacy. The TVI had learned about word bubbling in a conference. Word bubbling is a promising practice suggested by Christine Roman in her book Cortical Visual Impairment: Advanced Principles.

This TVI took the app for word bubbling and suggested that all the child’s literacy materials were bubbled.

  • This does not match the student’s visual skills. Central vision use would be essential for this intervention.
  • This is not the suggested practice from the text: Cortical Visual Impairment: Advanced Principles.
  • This was randomly applied with no diagnostic evaluation of the tool as applied to the student.
  • The TVI never partnered with the reading specialist who would be the expert about the teaching of reading. That collaboration would be essential.
  • There was no data on the effectiveness of this strategy for this unique learner.

Here is just one example of a sentence this poor student is now struggling visually recognize:

 

Please:

  • Understand your student’s visual behaviors.
  • Try promising practices with careful consideration of those visual behaviors.
  • Use the strategy as it was meant to be used.
  • Collect data on the effectiveness of your trial. (Baseline data then progress data)
  • Random application of any strategy is as inaccessible as doing nothing..

Are You Making Your Assessment and Service to Learners with CVI Fun?

First and foremost, our children with CVI are children. Children love predictable games, funny noises, and social interactions. Children like to play the same games over and over again. We can get our goals and objectives accomplished with learners if we understand what makes learners happy and what it is that they deeply enjoy. The parent is the most essential reporter of their child’s preferences. We need to move away from what we think children will like to what the parent knows the child will like. That is the basis for faster, fuller and longer lasting learning.

Some ideas, based on assessment of the child’s visual skills:

Instead of holding materials to gain a child’s visual attention and once they look you move on to another object, create a game that sparks a social, auditory and tactile sequence.

  • “Find the pom pom. It is silver with many shiny streamers”. Once the child looks, wiggle and tickle their arm while making a funny noise.
  • The parent reports that the child likes his/her feet tickled. Present an object that can represent that tickling game. “Here is the symbol for tickling. It is yellow and round like a ball”. Once the child looks, tickle their toes using a funny voice!
  • For literacy, pick a predictable book with a distinctive colored cover. Make sure is enjoyed by the child. Once the child looks, “That is the Farm Animal book with funny sounds. The book is square with a green cover”.

Why? All kids are kids no matter their abilities.

  • Creating fun, predictable interactions with children is the basis of a strong trusting relationship which allows the child to show you optimal skills in all areas. (Another plug for direct service to students with CVI)
  • When interactions and learning are based on what the child likes, the memory of that interaction is solidly stored in the brain.
  • Fun interactions guarantee that the child will be motivated to communicate at the highest possible level. (Expanded Core Curriculum area)
  • Creating visual recognition using these “symbols” for games allows you to build a repertoire of symbols that will be the basis for choice making based on building visual recognition.
  • When you see the way children communicate (large body movements, smiling, raising their arms or vocalizing), you can acknowledge that communication and help the child understand your needs for understanding their communication. “I see a big smile (touch the side of their mouth in an upward motion). When I see that smile I know you want more”. “I see a large body movement. That tells me you like this game”.
  • You can build literacy choices and experiences supported by storyboxes, yet another set of visual opportunities. http://www.pathstoliteracy.org/storybox-ideas-norma-drissel
  • You will have fun too!

Perkins 5th Annual Symposium

The Perkins 5th Annual Symposium this July 11th and 12th, 2019 was a huge success! The first day there were three panels. The second day, workgroups formed to discuss the needs in each topic.

The first panel, Medical and Research, laid out the current state of medical understanding and research about CVI. The panelists lead by Lotfi Merabet, OD, Ph.D., were Sharon Lehman, MD, Barry Kran, OD, FAAO, Terry Schwartz, MD and Corrina Bauer, Ph.D.

The second, Assessment and Promising Practices which I led, featured Matt Tietjen, M.Ed, Sandra Lewis, Ed.D, Tammy Reisman, CAES, Christine Roman-Lantzy, Ph.D.

The third, Family Education and Advocacy, lead by Tracy Evans-Luiselli, Ed.D., featured Rachel Bennett M.Ed., Bobby Silverstein, Esq., Barbara Raimondo, Esq. and Monika Jones, Esq..

Repeated themes shared overwhelmingly throughout the panels:

  • Kids can’t wait. They are in our homes, offices, and schools now in overwhelming numbers. Those numbers will continue to grow in the United States and across the globe.
  • Parents and students are critical partners.
  • Researchers, medical professional, educators and parents need more information about CVI.
  • CVI is complex and needs a team approach for diagnosis, assessment and planned intervention.
  • Individuals with CVI are unique and deserve unique considerations in assessment and interventions.
  • We need more assessment tools and more researched interventions that work for learners with CVI.
  • The infighting about the name: cortical, cerebral or neurological visual impairment is a roadblock to understanding, identification, assessment and service to individuals with CVI. Fighting about the name will impede progress in all areas especially in advocacy at the government level.
  • Together with consensus, we can move this forward. If we are fractured, we will stall efforts for research, assessment, advocacy and service to students.

The overall issues were identified and workgroups formed to tease out details in the four areas of Medical/Research, Assessment and Interventions, Advocacy and the Higher Education training of vision professionals to serve students with CVI.

With Perkins support and commitment, the work will continue from the identified collective wisdom of the workgroups.

Perkins CVI Symposium July 11th and 12th, 2019

Join us for the annual CVI Symposium at Perkins School for the Blind in Massachusetts. This is the first time this will be held off-campus in a conference center and the first time this will be a two day event. It will be very different from previous symposiums. The first day is panel discussions with leaders in the field of CVI. The next day is a working day to more CVI forward. You can attend groups of interest including:

  • Medical and Research working group
  • Assessment working group
  • Higher Education working group
  • Advocacy working group

Find more information here at:

http://www.perkinselearning.org/earn-credits/onsite-training/cvi-symposium

 

Phase III: Child with Visual Recognition Difficulties

My friend is a parent of a child with CVI with visual recognition problems. On the CVI Range, he scores in Phase III (Roman-Lantzy). She constantly describes the impact of CVI on her son that she witnesses every single day. These children with visual recognition problems due to CVI have really, really good central vision use that is consistently used. Because they are looking, people think they have visual access just like we do.

This is her story about a family trip to Montreal. Of course, Omer really doesn’t care for these adventures into noisy, busy and new environments where objects and people are not known and therefore not understood. CVI is an issue of visual recognition after all. He wants to stay in the hotel room that is quiet with few people moving around. He understands and can visually predict the bed, bureau, TV and chairs. He knows the people in the room are his family so that reduces the stress. Because the family understands this difficulty, they picked a quiet restaurant for lunch.

On the table at the quiet restaurant, Omer he saw a glass of room temperature water with bubbles.

 

Omer never saw the bubbles in a glass of water before. A few weeks prior, he had seen and experimented with putting salt into water and drawing on that experience, thought the bubbles were salt. Pretty smart but wrong…

For kids with CVI and visual recognition problems, it takes so long for them to visually process newly seen events and materials. Omer was working so hard to close the gap of information that he missing. He is desperately trying to link previous information to this novel visual target.

Omer never saw the bubbles in a glass of water before. It was his first time seeing it and he was fascinated! He asked his mother to take a picture of it so he could zoom in for a good look and verbal explanation.

I am so proud of Omer’s advocacy! What I do worry about is what is number of times in his day that he encounters items, people and events he doesn’t understand and the we, with perfect vision, forget to make accessible?

Chose Vision for IEP Eligibility

Vision is the primary learning mode for children with perfect vision. Vision gathers information quickly, links previous learning to new learning and links information from all the other senses for a full and complete understanding.

We know that for children with CVI, vision is the primary disability. For children with CVI, their visual impairment impacts all access to all of the general education curriculum. Their visual impairment impact all access to all of the special education curriculum.

Identifying the student with CVI and determining eligibility as “Vision” ensures that a teacher of students with visual impairments is part of the team and that there is consideration of the Expanded Core Curriculum. The Expanded Core Curriculum addresses the Unique Disability-Specific Needs of a child with a visual impairment.

For a child with CVI:

  • Their lack of visual attention and visual recognition limits the effective gathering of information about how the world works.
  • Their lack of visual attention and visual recognition limits the effective gathering of information about how the people in the world behave.
  • Their lack of visual attention and visual recognition impacts their connecting, categorizing and classifying of information.
  • Their lack of visual attention and visual recognition limits their understanding of sound sources.
  • Their lack of visual attention and visual recognition requires direct experiences in natural environments.

The Expanded Core Curriculum includes these 9 areas:

  1. Compensatory skills
  2. Orientation and mobility skills
  3. Social interaction skills
  4. Independent living skills
  5. Recreation and leisure skills
  6. Career education
  7. Use of assistive technology
  8. Sensory efficiency skills
  9. Self-determination skills

This is not an extra curriculum. This is an essential curriculum for the child with visual impairment. These are skills that everyone needs to live and work successfully to their full potential. The critical difference for our children with CVI is ACCESS to these 9 skill area. Children with perfect vision begin their exposure to the Expanded Core Curriculum at birth. Children with CVI must have the same consideration.

Children with and without additional disabilities can have Expanded Core Areas addressed in their programming due to the absence of or reduction of incidental learning.

Children with CVI

  • lack access to all visual information which optimizes all the learning for their peers with perfect vision.
  • lack access to the same number of repeated opportunities for visual information to reinforce concepts which optimizes all learning for their peers with perfect vision.
  • lack access to visual experiences to link new information to old information which optimizes all learning for their peers with perfect vision.
  • lack the ability to access and practice continuously in naturally occurring environments which optimizes all learning for their peers with perfect vision.

CVI is a neurological condition but is manifests in a visual impairment. This visual impairment is the issue for all learning. For the eligibility section of the IEP, chose “Vision” and the primary disability and “Neurological” as the secondary disability.

Bring Vision to the forefront for all learning.